Pulse

Evangelist for Exercise

University of Minnesota professor and breast cancer survivor Wendy Rahn wants everyone to know that exercise after a cancer diagnosis may reduce the risk of dying from the disease.

Before she was diagnosed with breast cancer in 2006, getting to the gym was a low priority for Wendy Rahn, Ph.D. The University of Minnesota political science professor was busy trying to balance teaching and doing research with the demands of her family—her son was then 8. Working out seemed self-indulgent. In fact, she says, exercise had “dropped off the radar.”

After hormone therapy, a double mastectomy, and reconstructive surgeries, however, Rahn had a conversion experience. She had delved into the public health literature to learn more about cancer survival and was surprised to discover a study that linked exercise after a cancer diagnosis to not only having a better quality of life but also a longer one. The article, “Physical Activity and Survival after Breast Cancer Diagnosis,” which was published in the Journal of the American Medical Association (JAMA) in 2005, concluded that exercising three to five hours a week might reduce a breast cancer survivor’s risk of dying from the disease by as much as 50 percent. Rahn hired a personal trainer.

As she worked out and began to feel better, Rahn and her trainer wondered why no one had told her about the research on exercise. As Rahn saw it, pumping iron and pounding the pavement were matters of life and death. But neither her doctors nor her new friends in the cancer survivor community seemed to be talking about it. So in 2007, she formed a nonprofit, Survivors’ Training, with the goal of getting the word out.

Rahn assembled a board of directors and began studying to become a fitness instructor herself so that she could teach survivors how to exercise safely and teach others to work with cancer survivors. In 2008, she opened an exercise studio in White Bear Lake with a plan to hold classes for women who had been treated or were being treated for cancer.

Although the studio closed after only a few months because of financial difficulties, Survivors’ Training itself survived. In 2008, with a grant from the Minnesota affiliate of the Susan G. Komen for the Cure foundation and help from the Melpomene Institute for Women’s Health, it released a fitness DVD called “Celebrate Strength.” This year, the organization has received support from the Minnesota Society of Clinical Oncology, and the Minnesota Cancer Alliance awarded it a grant to develop a new fitness program for cancer survivors. Last month, its CREW (Cancer Recovery Exercise for Women) classes started at the Minneapolis Midtown YWCA. Rahn helped train the instructors.

Body of Evidence

Rahn has taken the message about the benefits of exercise to the public, cancer survivors, and medical providers alike. She co-chairs the Minnesota Cancer Alliance’s team on continuing education on survivorship. She speaks to survivor groups, talks to physicians and other providers, trains fitness instructors, and maintains a website that summarizes the research on exercising after cancer. In 2009, such efforts earned her a Spirit of Collaboration Award from the Minnesota Cancer Alliance.

One of those whom Rahn introduced to the research on exercise and cancer mortality is Brian Rank, M.D., medical director for HealthPartners Medical Group and Clinics. Rank says he was only peripherally aware of the literature until Rahn brought it to the attention of the Minnesota Cancer Alliance. “It takes an advocate like Wendy to bring [the literature on exercise] to people’s attention,” he says. He now sits on the board of directors for Survivors’ Training.

That literature now includes a study of 933 women, the results of which were published in JAMA in 2008, that found those who increased their physical activity after a breast cancer diagnosis had a 45 percent lower risk of death than women who were inactive both before and after their diagnosis, and that women who decreased their physical activity after diagnosis had a four-fold greater risk of death.

Similar studies are being done in patients with other types of cancer. An article published in the Journal of Clinical Oncology in 2006 reports that physical activity after the diagnosis of certain colorectal cancers might reduce the risk of colorectal-cancer-specific and overall mortality. And researchers from Harvard University have reported that men who had prostate cancer who engaged in vigorous physical activity after their diagnosis had a lower risk of dying from any cause. “Almost once a week an article comes out showing the benefits of exercise in one disease or another,” Rank says. “I think the literature in support of exercise is becoming overwhelming.”

The importance of exercising after a cancer diagnosis is starting to be recognized in Minnesota’s survivorship, integrative oncology, and cancer rehabilitation programs. For example, the Mayo Clinic Cancer Center promotes it as a way for the survivor to reduce risk factors for cancer. Sister Kenny Rehabilitation Institute at Abbott Northwestern Hospital offers it as a component of its cancer rehabilitation and lymphedema services. And Minnesota hospital survivorship programs are starting to tell patients about the benefits of exercise, and some even offer classes.

Rx for Ex?

Whether oncologists are actually “prescribing” it, which is what Rahn would like to see, is another story. Charles Loprinzi, M.D., Regis Professor of Breast Cancer Research at Mayo Clinic, says he tries to work a recommendation for exercise into the conversations he has with his patients about making all kinds of lifestyle changes. Yet although he believes the benefits of exercise are well-established, he doesn’t necessarily recommend it to every patient at every visit. “Do I bring it up with everybody? I try to, but it all depends on what other topics need to be discussed given the time constraints,” he says.

Similarly, Randy Hurley, M.D., medical director of oncology for HealthPartners and Regions Hospital in St. Paul, says fitting a discussion about the research on exercise into an office visit can be tough. “I think there’s no reason not to lift up exercise as a way to improve cancer outcomes,” he says. “It’s just that on the laundry list of things to get through in a 20- or 30-minute appointment, that’s one more.” Hurley appreciates that others, like Rahn, are calling attention to the topic.

Anne Blaes, M.D., who sees patients at the University of Minnesota’s Long-Term Follow-Up Clinic, tells patients that the research is indicating that exercise may help reduce the recurrence of breast and colorectal cancer in particular. “While we really need more data to know for sure,” she says, “I encourage patients, particularly after therapy, to exercise. If anything, we know it helps the cardiovascular system, which whether you are a cancer survivor or not, still remains a leading cause of death in our country.”

HealthPartners’ Rank predicts exercise may eventually be added to the list of lifestyle recommendations oncologists routinely give to patients. But he says that even if it is, physicians will struggle with getting patients to do it. “How do we get people eating better, exercising more, getting out of cars, and walking? We haven’t hit on the answer yet.”

At this point, survivors such as Rahn may be the best evangelists for exercise. Looking calm, fit, and strong on the screen in the “Celebrate Strength” video, Rahn herself is a convincing argument for doing the stretches, lifts, and movements that the trainers are about to lead viewers through. In addition, she carefully builds the case for exercising after cancer and explains that the DVD is structured so that women who are recovering from surgery or weak from treatment can begin slowly and progress as they regain strength and stamina.

She empathizes with the viewer, noting that it might be difficult to start. “I would consider myself a lapsed exerciser,” she confesses, then reveals what keeps her motivated, “but then I read a study that completely changed my world.”—Carmen Peota